Question
What does CD4, CD8 and CD4/CD8 ratio mean?
25 September 2023. Related: All topics, CD4 and viral load.
Hi, I was diagnosed on March this year, when I got diagnosed, I didn’t get tested for my Viral Load or CD4 count. 2 months in, I got my Viral Load tested with the result of 100 copies/mL. I just got my CD4 tested, the result is 243 cells/microliter, yes, below the 350 or 500 count sadly. My CD4% is 14.6 below the 29% threshold. However, my CD8 count is within the normal range, 984 cells/microliter. What does this mean? As my CD4/CD8 ratio is still below 1
Answer
Hi, how are you doing?
It is great that your viral load is now 100. Are you on treatment? If you are it shows that your treatment is working and HIV is being suppressed. A viral load of 100 is considered undetectable and means you cannot pass on HIV via sex, even without a condom. This is called U=U.
As you now have a suppressed viral load, this will allow your CD4 count to recover. Unlike viral load which responds very quickly to treatment, this is a slower process but it will start to go up. Have you been given an antibiotic called co-trimoxazole? While you have a weaker immune system, often people are given this to prevent other infections.
CD8 is not damaged by HIV. This is why this cell type is within a healthy range. Your CD4/CD8 ratio is less than 1 because it is determined by the number of CD4 cells divided by the number of CD8 cells. Most people should have a ratio of 1-1.9. This would mean you have 1-2 CD4 cells for every CD8 cell. Your ratio is lower because you are still waiting for your CD4 cells to recover.
Josh.
Dear Anastasia – thanks for posting your comment – I am covering the service for Josh this month – but it is easy to respond to your questions.
First, it is great you are doing so well. Do you know your latest viral load count as you didn’t mention this.
Once you are taking HIV meds, your viral load is more important than these other tests. So long as viral load is undetectable, the CD4 count is much less important.
Secondly though, all the results you have listed are all roughly the same. Nothing is getting any worse here, the results just show you are stable and doing well.
14% and 13.8% are the same as are 0.3 compared to 0.25.
All these tests fluctuate every day and they are not accurate enough for smal differences to mean anything. A doctor should interpret these as the same and there isn’t the hint of a trend :)
Food doesn’t affect any of these tests either.
Hi Josh,
This month marks the one-year anniversary of my HIV diagnosis. I feel like I’m doing great and I’m so proud that I can withstand the cold, unlike people around me. So, I was very optimistic when I took the CD4-CD8 test yesterday. However now, I don’t know what to make of the result.
My CD4 number is 286 cells/microliter which is higher than 6 months ago which was 243 cells/microliter.
My CD4 % slipped below the 14% benchmark to 13.8%, lower than 6 months ago which was 14.6%, 0.8% drop but still.
My CD8 is quite high, 1306, pass the 1129 upper benchmark of CD8. My CD8% percentage is also high which is 63.2%, pass the 39% upper benchmark.
My ratio CD4:CD8 also drops by .03 to 0.22 from 0,25.
I don’t know how to make up the numbers. I will be going to my doctor tomorrow, but I want your opinions.
1. What does it mean if my CD4 number is trending upwards yet my CD4% is not? I read on an AIDSmap infographic that CD4% is more reliable than the numbers, is it true?
2. Is there an abstinence period that I need to adhere to before taking the CD4-CD8 or the Viral Load test? because a week before this test I had unprotected sex, does it maybe affect this confusing set of results for me?
Thank you so much for the answer !
Hi Anastasia, thanks for this feedback. It is always welcomed. It is great that you are feeling more calm about the situation.
Hi Josh, OP here. I know that my posts are usually not specifically about thanking you or the i-base great work. However, your reply made me felt very safe and calm.
I want to thank you as well for the FDA reference on the copy to IU conversion, as your reference is more recent than the WHO Guideline which I found.
https://www.researchgate.net/post/How-to-convert-HIV-Copies-mL-to-IU-mL
Ahmed Fakr Answer on March 2020.
With the 0,613 IU to 1 copy, this assurance gave me some sanity to the bizarre and horrible occurrences I endured last week. The objective observation made me feel safe about how I strategize my body’s health from now on.
Hi Anastasia, I am sorry to hear about how your care is being provided.
A 5-point increase is not something that you should be made to feel scared about. Regalrdess of this being copies or IU, the increase is still not significant and did not warrant going to see your doctor about.
I cannot find reference to the guideline you have mentioned. I have only come across 1 copy = 1.63 as mentioned here: https://www.fda.gov/media/159973/download
Regardless, this still remains a relatively small conversion with not much clinical impact. Using these conversions, you can have a result of 326 IY and this be equivalent to 200 copies in which U=U can still apply. It is normal for viral load to fluctuate.
Hi Josh, it’s the OP here. This post is going to be part venting and part question.
Long story short, in my country, there are these “handlers”, liaison officers, or point contact persons, from the health clinic to patients with HIV (PWH). After my last viral load test, my handler told me through text that 1). the value had increased, and 2). He thought that it would be better if I consulted it with my doctor. Those texts made me scared, and anxious, considering there was only a 5-point increase, way below the 200 copies/mL threshold.
I went to see my doctor, and she couldn’t figure out why the value increased by 5 points. And I felt even more confused and scared, scared that it was maybe a case of resistance or something.
After the consultation, I kept on asking my handler as to what the unit of measurement that the result was in because the doctor once mentioned when I was in her office that the unit of measurement was not copies/mL and the 200 copies/mL threshold was not valid. After a long back and forth of dodging my questions and denying the claim that he obligated me to see the doctor, he finally confirmed the statement that I had said earlier, and the unit used was “international units”/mL. After that he called me out of the blue and harangued me, in the most passive-aggressive and killer-cheery manner way.
TLDR; my handler scared me about the 5-point increase, yet when I confronted him about the significance of the 5-point increase, he gaslight me and harangued me for “blaming me”
my question is : is it true that 1 copy = 1.72 copy (based on a 2017 WHO guideline and 2012 ACL Lab guideline)? If not, what is the equivalent of 1 international unit of HIV to copy? Can you give me references to it?
Because 100 IU/mL= around 58 copies/mL, or 105 IU/mL= around 65 copies/mL. I really don’t get why they need to scare me because of the 7 copies increase of my HIV.
I’ve been doing my best to protect myself after the diagnosis. Their fear-mongering tactic made me felt like I have not been taking my medicine regularly on the dot, despite the fact that I have been, and somehow I have not been abstinent for the longest period of my life.
Hi Anastasia, this is normal and you do not need to worry.
An increase of 5 copies is not considered a clinically significant increase. Small changes in viral load are expected over time.
As your viral load is suppressed, small changes up and down are expected in following viral load tests.
Hi Josh, I’m OP here. I hope you and the whole i-base.info team are having a great holiday season.
I got another viral load test on October 2023, and I just received the result today. My viral load level was 105 copies/mL. 5 copies/mL higher than the previous result. Is it normal for my result to increase a little bit, albeit still below the 200 copies/mL threshold?
Thank you for your help!
Hi Anastasia, while it seems like wanting a viral load under 20 is the goal, it is still the same as any value below 200. There is no clinical difference between the values. As long as your viral load is below 200 HIV will not be impacting your immune system and you will not be able to pass on HIV.
Keep us updated on how your next visit with your doctor goes.
Hi, I’m the OP. I didn’t get the notification that my question got answered. Thank you so much for the answer. Yes I have read based off of an NHS pamphlet and an AIDS map blog post that most studies put the viral load under 200 copies/mL as U=U. However, I’m still waiting for the under 20 copies/mL result. Yes, I’m already on Acriptega.
Thank you so much for saying the fact about how HIV doesn’t impact CD8, I was afraid my result is an outlier or something.
No, I’m not on co-trimoxazole. My doctor hasn’t even talked about it. I think I will bring the topic up when I’m gonna take the Viral Load test in November